2025 HESI RN MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS WITH
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
The nurse is assessing a client with acute pancreatitis. Which B
finding requires the most immediate intervention by the nurse? The nurse is assessing a client with acute pancreatitis. Which
A. finding requires the most immediate intervention by the nurse?
The client's amylase level is three times higher than the normal Rationale:A positive Trousseau sign indicates hypocalcemia and
level. always requires further assessment and intervention, regardless
B. of the cause (40% to 75% of those with acute pancreatitis experi-
The client has a carpal spasm when taking a blood pressure. ence hypocalcemia, which can have serious, systemic effects). A
C. key diagnostic finding of pancreatitis is serum amylase and lipase
On a 1 to 10 scale, the client tells the nurse that her epigastric pain levels that are two to five times higher than the normal value.
is at 7. Severe boring pain is an expected symptom for this diagnosis, but
D. dealing with the hypocalcemia is a priority over administering an
The client states that she will continue to drink alcohol after going analgesic. Long-term planning and teaching do not have the same
home. immediate importance as a positive Trousseau sign.
A 55-year-old male client has been admitted to the hospital with
a medical diagnosis of chronic obstructive pulmonary disease C
(COPD). Which risk factor is the most significant in the develop- Rationale:Smoking, considered to be a modifiable risk factor, is
ment of this client's COPD? the most significant risk factor for the development of COPD.
A. The exact mechanism of genetic and hereditary implications for
The client's father was diagnosed with COPD in his 50s. the development of COPD is still under investigation, although
B. exposure to similar predisposing factors (e.g., smoking or inhaling
A close family member contracted tuberculosis last year. secondhand smoke) may increase the likelihood of COPD inci-
C. dence among family members. Options B and D do not exceed
The client smokes one to two packs of cigarettes per day. the risks associated with cigarette smoking in the development of
D. COPD.
The client has been 40 pounds overweight for 15 years.
In assessing a client diagnosed with primary aldosteronism, the
nurse expects the laboratory test results to indicate a decreased
serum level of which substance? C
A. Rationale:Clients with primary aldosteronism exhibit a profound
Sodium decline in serum levels of potassium; hypokalemia; hypertension
B. is the most prominent and universal sign. The serum sodium level
Phosphate is normal or elevated, depending on the amount of water resorbed
C. with the sodium. Option B is influenced by parathyroid hormone
Potassium (PTH). Option D is not affected by primary aldosteronism.
D.
Glucose
The nurse is completing an admission interview for a client with
Parkinson disease. Which question will provide additional infor-
mation about manifestations that the client is likely to experience? C
A.
Rationale:Clients with Parkinson disease frequently experience
"Have you ever experienced any paralysis of your arms or legs?"
difficulty in initiating, maintaining, and performing motor activities.
B.
They may even experience being rooted to the spot and unable to
"Do you have frequent blackout spells?"
move. Parkinson disease does not typically cause option A, B, or
C.
D.
"Have you ever been frozen in one spot, unable to move?"
D.
"Do you have headaches, especially ones with throbbing pain?"
Client census is often used to determine staffing needs. Which
method of obtaining census determination for a particular unit
provides the best formula for determining long-range staffing pat- C
terns? Rationale:An average daily census is determined by trend data
A. and takes into account seasonal and daily fluctuations, so it is
Midnight census the best method for determining staffing needs. Options A and B
B. provide data at a certain point in time, and that data could change
Oncoming shift census quickly. It is unrealistic to expect to obtain an hourly census, and
C. such data would only provide information about a certain point in
Average daily census time.
D.
Hourly census
A male client has just undergone a laryngectomy and has a cuffed
tracheostomy tube in place. When initiating bolus tube feedings
, 2025 HESI RN MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS WITH
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
postoperatively, when should the nurse inflate the cuff?
B
A.
Rationale:The cuff should be inflated before the feeding to block
Immediately after feeding
the trachea and prevent food from entering if oral feedings are
B.
started while a cuffed tracheostomy tube is in place. It should
Just prior to tube feeding
remain inflated throughout the feeding to prevent aspiration of food
C.
into the respiratory system. Options A and D place the client at
Continuous inflation is required
risk for aspiration. Option C places the client at risk for tracheal
D.
wall necrosis.
Inflation is not required
A client with a nasogastric tube attached to low suction states that
she is nauseated. The nurse assesses that there has been no
drainage through the nasogastric tube in the last 2 hours. Which
B
action should the nurse take first?
Rationale:The immediate priority is to determine if the tube is
A.
functioning correctly, which would then relieve the client's nausea.
Irrigate the nasogastric tube with sterile normal saline.
The least invasive intervention, repositioning the client, should
B.
be attempted first, followed by options A and C, unless either
Reposition the client on her side.
of these interventions is contraindicated. If these measures are
C.
unsuccessful, the client may require option D.
Advance the nasogastric tube 5 cm.
D.
Administer an intravenous antiemetic as prescribed.
The nurse is conducting an osteoporosis screening clinic at a
health fair. What information should the nurse provide to individ-
uals who are at risk for osteoporosis? (Select all that apply.)
A.
A, C, D
Encourage alcohol and smoking cessation.
Rationale:Options A, C, and D are factors that decrease the risk
B.
for developing osteoporosis. Vitamin D and calcium are important
Suggest supplementing diet with vitamin E.
supplements to aid in the decrease of bone loss. Regular sleep
C.
patterns are important to overall health but are not identified with
Promote regular weight-bearing exercises.
a decreasing risk for osteoporosis.
D.
Implement a home safety plan to prevent falls.
E.
Propose a regular sleep pattern of 8 hours nightly.
A
Which nursing action would be appropriate for a client who is Rationale:Cushing syndrome results from a hypersecretion of glu-
newly diagnosed with Cushing syndrome? cocorticoids in the adrenal cortex. Clients with Cushing syndrome
A. often develop diabetes mellitus. Monitoring of serum glucose lev-
Monitor blood glucose levels daily. els assesses for increased blood glucose levels so that treat-
B. ment can begin early. A common finding in Cushing syndrome is
Increase intake of fluids high in potassium. generalized edema. Although potassium is needed, it is generally
C. obtained from food intake, not by offering potassium-enhanced
Encourage adequate rest between activities. fluids. Fatigue is usually not an overwhelming factor in Cushing
D. syndrome, so an emphasis on the need for rest is not indicated. A
Offer the client a sodium-enriched menu. low-calorie, low-carbohydrate, low-sodium diet is not recommend-
ed.
A 58-year-old client who has no health problems asks the nurse
about receiving the pneumococcal vaccine. Which statement giv-
en by the nurse would offer the client accurate information about B
this vaccine? Rationale:It is usually recommended that persons older than 65
A. years and those with a history of chronic illness should receive
The vaccine is given annually before the flu season to those older the vaccine once in their lifetime. Some recommend receiving
than 50 years. the vaccine at 50 years of age. The influenza vaccine is given
B. once a year. Although the vaccine might be given to a person
The immunization is administered once to older adults or those at traveling overseas, that is not the main rationale for administering
risk for illness. the vaccine.The vaccine is usually given once in a lifetime, but with
C. immunosuppressed clients or clients with a history of pneumonia,
The vaccine is for all ages and is given primarily to those persons revaccination is sometimes required.
traveling overseas to areas of infection.
D.
, 2025 HESI RN MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS WITH
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
The vaccine will prevent the occurrence of pneumococcal pneu-
monia for up to 5 years.
A client is admitted to the hospital with severe lower left abdominal
pain, nausea, vomiting, fever, and chills. Which nursing action has
the highest priority?
A
A.
Rationale:A client is showing signs of acute severe diverticulitis
Place the client on NPO status.
and is at risk for peritonitis and intestinal obstruction. The nurse
B.
should make the client NPO to reduce risk of intestinal rupture.
Assess the client's temperature.
Options B, C, and D are important but are less of a priority than
C.
option A, which is implemented to prevent a severe complication.
Obtain a stool specimen.
D.
Administer IV fluids.
A client on telemetry has a pattern of uncontrolled atrial fibrillation
with a rapid ventricular response. Based on this finding, the nurse B
anticipates assisting the physician with which treatment? Rationale:With uncontrolled atrial fibrillation, the treatment of
A. choice is synchronized cardioversion to convert the cardiac rhythm
Administer lidocaine, 75 mg intravenous push. back to normal sinus rhythm. Option A is a medication used for
B. ventricular dysrhythmias. Option C is not for a client with atrial fib-
Perform synchronized cardioversion. rillation; it is reserved for clients with life-threatening dysrhythmias,
C. such as ventricular fibrillation and unstable ventricular tachycardia.
Defibrillate the client as soon as possible. Option D is the drug of choice in symptomatic sinus bradycardia,
D. not atrial fibrillation.
Administer atropine, 0.4 mg intravenous push.
The nurse is preparing a client for discharge after a right total
knee replacement. Which client statements about use of a walker
indicate to the nurse the teaching was effective? (Select all that
apply.)
A.
"I will walk in the middle of the walker."
A, B, C
B.
Rationale:The nurse is teaching about use of a walker. Having the
"I will make sure all four feet of the walker are on the floor before
walker collapsed at night does not help with nighttime ambulation
I use the hand pieces."
to the restroom. The client is at risk for falling. Silicone is a slippery
C.
"I will move my right foot forward into the walker, and then my left material and placing silicone on the rubber tips of the walker
places the client at risk for falling. The remaining client statements
foot."
about use of a walker are correct.
D.
"I will collapse the walker and put it in the chair opposite the bed
at night."
E.
"I will use a silicone-based cleaning product to clean the hand
pieces and rubber tips."
A resident in a long-term care facility is diagnosed with hepatitis
B. Which action should the nurse take with the staff caring for this
client?
A.
Determine if all employees have had the hepatitis B vaccine A
series. Rationale:Hepatitis B vaccine should be administered to all health
B. care providers. Hepatitis A (not hepatitis B) can be transmitted
Explain that this type of hepatitis can be transmitted when feeding by fecal-oral contamination. There is a chance that staff could
the client. contract hepatitis B if exposed to the client's blood and/or body
C. fluids; therefore, option C is incorrect. There is no need to wear
Assure the employees that they cannot contract hepatitis B when gloves and gowns except with blood or body fluid contact.
providing direct care.
D.
Tell the employees that wearing gloves and a gown are required
when providing all care.
The nurse is providing care to a client admitted to the emergency
room with a blood glucose level of 40 mg/dL and is semiconscious.
What are the nurse's next actions? (Select all that apply.)
A.
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
The nurse is assessing a client with acute pancreatitis. Which B
finding requires the most immediate intervention by the nurse? The nurse is assessing a client with acute pancreatitis. Which
A. finding requires the most immediate intervention by the nurse?
The client's amylase level is three times higher than the normal Rationale:A positive Trousseau sign indicates hypocalcemia and
level. always requires further assessment and intervention, regardless
B. of the cause (40% to 75% of those with acute pancreatitis experi-
The client has a carpal spasm when taking a blood pressure. ence hypocalcemia, which can have serious, systemic effects). A
C. key diagnostic finding of pancreatitis is serum amylase and lipase
On a 1 to 10 scale, the client tells the nurse that her epigastric pain levels that are two to five times higher than the normal value.
is at 7. Severe boring pain is an expected symptom for this diagnosis, but
D. dealing with the hypocalcemia is a priority over administering an
The client states that she will continue to drink alcohol after going analgesic. Long-term planning and teaching do not have the same
home. immediate importance as a positive Trousseau sign.
A 55-year-old male client has been admitted to the hospital with
a medical diagnosis of chronic obstructive pulmonary disease C
(COPD). Which risk factor is the most significant in the develop- Rationale:Smoking, considered to be a modifiable risk factor, is
ment of this client's COPD? the most significant risk factor for the development of COPD.
A. The exact mechanism of genetic and hereditary implications for
The client's father was diagnosed with COPD in his 50s. the development of COPD is still under investigation, although
B. exposure to similar predisposing factors (e.g., smoking or inhaling
A close family member contracted tuberculosis last year. secondhand smoke) may increase the likelihood of COPD inci-
C. dence among family members. Options B and D do not exceed
The client smokes one to two packs of cigarettes per day. the risks associated with cigarette smoking in the development of
D. COPD.
The client has been 40 pounds overweight for 15 years.
In assessing a client diagnosed with primary aldosteronism, the
nurse expects the laboratory test results to indicate a decreased
serum level of which substance? C
A. Rationale:Clients with primary aldosteronism exhibit a profound
Sodium decline in serum levels of potassium; hypokalemia; hypertension
B. is the most prominent and universal sign. The serum sodium level
Phosphate is normal or elevated, depending on the amount of water resorbed
C. with the sodium. Option B is influenced by parathyroid hormone
Potassium (PTH). Option D is not affected by primary aldosteronism.
D.
Glucose
The nurse is completing an admission interview for a client with
Parkinson disease. Which question will provide additional infor-
mation about manifestations that the client is likely to experience? C
A.
Rationale:Clients with Parkinson disease frequently experience
"Have you ever experienced any paralysis of your arms or legs?"
difficulty in initiating, maintaining, and performing motor activities.
B.
They may even experience being rooted to the spot and unable to
"Do you have frequent blackout spells?"
move. Parkinson disease does not typically cause option A, B, or
C.
D.
"Have you ever been frozen in one spot, unable to move?"
D.
"Do you have headaches, especially ones with throbbing pain?"
Client census is often used to determine staffing needs. Which
method of obtaining census determination for a particular unit
provides the best formula for determining long-range staffing pat- C
terns? Rationale:An average daily census is determined by trend data
A. and takes into account seasonal and daily fluctuations, so it is
Midnight census the best method for determining staffing needs. Options A and B
B. provide data at a certain point in time, and that data could change
Oncoming shift census quickly. It is unrealistic to expect to obtain an hourly census, and
C. such data would only provide information about a certain point in
Average daily census time.
D.
Hourly census
A male client has just undergone a laryngectomy and has a cuffed
tracheostomy tube in place. When initiating bolus tube feedings
, 2025 HESI RN MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS WITH
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
postoperatively, when should the nurse inflate the cuff?
B
A.
Rationale:The cuff should be inflated before the feeding to block
Immediately after feeding
the trachea and prevent food from entering if oral feedings are
B.
started while a cuffed tracheostomy tube is in place. It should
Just prior to tube feeding
remain inflated throughout the feeding to prevent aspiration of food
C.
into the respiratory system. Options A and D place the client at
Continuous inflation is required
risk for aspiration. Option C places the client at risk for tracheal
D.
wall necrosis.
Inflation is not required
A client with a nasogastric tube attached to low suction states that
she is nauseated. The nurse assesses that there has been no
drainage through the nasogastric tube in the last 2 hours. Which
B
action should the nurse take first?
Rationale:The immediate priority is to determine if the tube is
A.
functioning correctly, which would then relieve the client's nausea.
Irrigate the nasogastric tube with sterile normal saline.
The least invasive intervention, repositioning the client, should
B.
be attempted first, followed by options A and C, unless either
Reposition the client on her side.
of these interventions is contraindicated. If these measures are
C.
unsuccessful, the client may require option D.
Advance the nasogastric tube 5 cm.
D.
Administer an intravenous antiemetic as prescribed.
The nurse is conducting an osteoporosis screening clinic at a
health fair. What information should the nurse provide to individ-
uals who are at risk for osteoporosis? (Select all that apply.)
A.
A, C, D
Encourage alcohol and smoking cessation.
Rationale:Options A, C, and D are factors that decrease the risk
B.
for developing osteoporosis. Vitamin D and calcium are important
Suggest supplementing diet with vitamin E.
supplements to aid in the decrease of bone loss. Regular sleep
C.
patterns are important to overall health but are not identified with
Promote regular weight-bearing exercises.
a decreasing risk for osteoporosis.
D.
Implement a home safety plan to prevent falls.
E.
Propose a regular sleep pattern of 8 hours nightly.
A
Which nursing action would be appropriate for a client who is Rationale:Cushing syndrome results from a hypersecretion of glu-
newly diagnosed with Cushing syndrome? cocorticoids in the adrenal cortex. Clients with Cushing syndrome
A. often develop diabetes mellitus. Monitoring of serum glucose lev-
Monitor blood glucose levels daily. els assesses for increased blood glucose levels so that treat-
B. ment can begin early. A common finding in Cushing syndrome is
Increase intake of fluids high in potassium. generalized edema. Although potassium is needed, it is generally
C. obtained from food intake, not by offering potassium-enhanced
Encourage adequate rest between activities. fluids. Fatigue is usually not an overwhelming factor in Cushing
D. syndrome, so an emphasis on the need for rest is not indicated. A
Offer the client a sodium-enriched menu. low-calorie, low-carbohydrate, low-sodium diet is not recommend-
ed.
A 58-year-old client who has no health problems asks the nurse
about receiving the pneumococcal vaccine. Which statement giv-
en by the nurse would offer the client accurate information about B
this vaccine? Rationale:It is usually recommended that persons older than 65
A. years and those with a history of chronic illness should receive
The vaccine is given annually before the flu season to those older the vaccine once in their lifetime. Some recommend receiving
than 50 years. the vaccine at 50 years of age. The influenza vaccine is given
B. once a year. Although the vaccine might be given to a person
The immunization is administered once to older adults or those at traveling overseas, that is not the main rationale for administering
risk for illness. the vaccine.The vaccine is usually given once in a lifetime, but with
C. immunosuppressed clients or clients with a history of pneumonia,
The vaccine is for all ages and is given primarily to those persons revaccination is sometimes required.
traveling overseas to areas of infection.
D.
, 2025 HESI RN MED SURG ACTUAL EXAM QUESTIONS AND ANSWERS WITH
RATIONALES|WELL STRUCTURED|100% PASS
QUESTIONS QUESTIONS
The vaccine will prevent the occurrence of pneumococcal pneu-
monia for up to 5 years.
A client is admitted to the hospital with severe lower left abdominal
pain, nausea, vomiting, fever, and chills. Which nursing action has
the highest priority?
A
A.
Rationale:A client is showing signs of acute severe diverticulitis
Place the client on NPO status.
and is at risk for peritonitis and intestinal obstruction. The nurse
B.
should make the client NPO to reduce risk of intestinal rupture.
Assess the client's temperature.
Options B, C, and D are important but are less of a priority than
C.
option A, which is implemented to prevent a severe complication.
Obtain a stool specimen.
D.
Administer IV fluids.
A client on telemetry has a pattern of uncontrolled atrial fibrillation
with a rapid ventricular response. Based on this finding, the nurse B
anticipates assisting the physician with which treatment? Rationale:With uncontrolled atrial fibrillation, the treatment of
A. choice is synchronized cardioversion to convert the cardiac rhythm
Administer lidocaine, 75 mg intravenous push. back to normal sinus rhythm. Option A is a medication used for
B. ventricular dysrhythmias. Option C is not for a client with atrial fib-
Perform synchronized cardioversion. rillation; it is reserved for clients with life-threatening dysrhythmias,
C. such as ventricular fibrillation and unstable ventricular tachycardia.
Defibrillate the client as soon as possible. Option D is the drug of choice in symptomatic sinus bradycardia,
D. not atrial fibrillation.
Administer atropine, 0.4 mg intravenous push.
The nurse is preparing a client for discharge after a right total
knee replacement. Which client statements about use of a walker
indicate to the nurse the teaching was effective? (Select all that
apply.)
A.
"I will walk in the middle of the walker."
A, B, C
B.
Rationale:The nurse is teaching about use of a walker. Having the
"I will make sure all four feet of the walker are on the floor before
walker collapsed at night does not help with nighttime ambulation
I use the hand pieces."
to the restroom. The client is at risk for falling. Silicone is a slippery
C.
"I will move my right foot forward into the walker, and then my left material and placing silicone on the rubber tips of the walker
places the client at risk for falling. The remaining client statements
foot."
about use of a walker are correct.
D.
"I will collapse the walker and put it in the chair opposite the bed
at night."
E.
"I will use a silicone-based cleaning product to clean the hand
pieces and rubber tips."
A resident in a long-term care facility is diagnosed with hepatitis
B. Which action should the nurse take with the staff caring for this
client?
A.
Determine if all employees have had the hepatitis B vaccine A
series. Rationale:Hepatitis B vaccine should be administered to all health
B. care providers. Hepatitis A (not hepatitis B) can be transmitted
Explain that this type of hepatitis can be transmitted when feeding by fecal-oral contamination. There is a chance that staff could
the client. contract hepatitis B if exposed to the client's blood and/or body
C. fluids; therefore, option C is incorrect. There is no need to wear
Assure the employees that they cannot contract hepatitis B when gloves and gowns except with blood or body fluid contact.
providing direct care.
D.
Tell the employees that wearing gloves and a gown are required
when providing all care.
The nurse is providing care to a client admitted to the emergency
room with a blood glucose level of 40 mg/dL and is semiconscious.
What are the nurse's next actions? (Select all that apply.)
A.
